acid-phosphatase and Adenocarcinoma--Mucinous

An 80-year-old man, who had been treated for colon cancer 25 years ago, presented with gross hematuria. Rectal examination revealed a soft nodule in the right lobe. The serum prostatic specific antigen (PSA) was elevated to 5.2 ng/ml, while prostatic acid phosphate (PAP) was normal. Transrectal ultrasound revealed a hypoechoic mass in peripheral zone of the prostate and dilated seminal vesicle. A needle biopsy of the prostate showed mucinous adenocarcinoma. Under the diagnosis of prostatic tumor with seminal vesicle involvement, radical prostatectomy was performed. Histological findings showed organ confined cancer, of which most was composed of extracellular mucin lakes. Immunohistochemical study revealed the tumor cells positive for PSA and PAP. Mucinous adenocarcinoma of the prostate has been known to be clinically different from non-mucinous adenocarcinoma, in that the former is insensitive to hormonal therapy, is rarely associated with elevated PAP and rarely metastasize to the bone. But our analysis of the literatures is Japan showed no significant difference clinically between mucinous and non mucinous prostatic adenocarcinoma. However mucinous adenocarcinoma with signet ring cell rarely responds to hormonal therapy, which should not be classified to true mucinous adenocarcinoma in the current criteria. True mucinous adenocarcinoma could be a variant of prostatic adenocarcinoma, which is peripheral origin and should be treated like non-mucinous adenocarcinoma.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Biomarkers, Tumor; Diagnosis, Differential; Humans; Immunohistochemistry; Male; Prostate-Specific Antigen; Prostatic Neoplasms

We report an uncommon case of primary prostatic signet-ring cell carcinoma which meets all criteria that define this clinicopathologic entity. Histologically, the tumor showed three different growth patterns, all of which contained large numbers of signet-ring cells. The predominant pattern, comprising approximately 50 percent of the tumor, was solid sheets of pure signet-ring cells. An intriguing finding was the presence of intestinal metaplasia involving the prostatic urethra and the large periurethral ducts. All mucin stains were intensely positive within the signet-ring cells and in the mucin lakes. Signet-ring cells stained positively for prostatic specific antigen, prostatic acid phosphatase, and carcinoembryonic antigen immunoperoxidase markers. Our patient presented with symptoms of urinary tract obstruction and locally widespread disease, infiltrating the rectum and the bladder, thus demonstrating the aggressive biologic behavior that traditionally has been ascribed to signet-ring cell carcinomas.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Carcinoembryonic Antigen; Humans; Immunohistochemistry; Male; Middle Aged; Mucins; Neoplasm Invasiveness; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

A 62-year-old male was admitted to our clinic with the complaints of gross-hematuria and miction pain. Cystoscopic examination revealed non-papillary tumor around the orifice of the left ureter and the left wall. Histopathological findings of the biopsy specimen demonstrated signet-ring cell carcinoma, and the specimen was stained positively by the peroxidase-antiperoxidase technique. No malignant findings in any other organs including gastrointestinal tract and prostate were detected. This patient underwent total cystectomy with ileal conduit and histopathological staging was pT3bNOMO. He was followed with no evidence of local recurrence or metastasis for 29 months after operation. The 45 reported cases with primary signet-ring cell carcinoma of the urinary bladder including our case are reviewed and some characteristics of this entry are discussed.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Combined Modality Therapy; Humans; Immunoenzyme Techniques; Male; Middle Aged; Neoplasm Staging; Prostate; Urinary Bladder Neoplasms

Prostatic urothelial-type adenocarcinoma arises through a process of glandular metaplasia of the prostatic urethral urothelium and subsequent in situ adenocarcinoma sometimes associated with villous adenoma. These prostatic adenocarcinomas are analogous to nonurachal adenocarcinomas arising in the bladder from cystitis glandularis. Only 2 cases of urothelial-type adenocarcinoma from an institution other than our own have been previously described. The distinction between adenocarcinoma from another organ secondarily involving the prostate, usual adenocarcinoma of the prostate, and prostatic urothelial-type adenocarcinoma can present a significant diagnostic challenge and has significant therapeutic implications. Fifteen cases of prostatic urothelial-type adenocarcinoma were retrieved from the consult files of one of the authors. Mean patient age at diagnosis was 72 years (range 58 to 93 y). All men had negative colonoscopies, clinically excluding a colonic primary. Bladder primaries were ruled out clinically or pathologically in radical resection specimens. Follow-up was available on all men with a mean of 50.3 months (range 2 to 161 mo). All men presented with urinary obstruction symptoms with 3 (20%) also having mucusuria and 2 (13.3%) also having hematuria. Four men (26.7%) developed metastatic disease and 8 (53.3%) died of disease. In 8/15 (53%) cases, glandular metaplasia of the prostatic urethra and contiguous transition to adenocarcinoma were identified. Multiple histologic patterns were observed including dissection of the stroma by mucin pools 15/15 (100%), villous features 7/15 (47%), necrosis 2/15 (13.3%), signet ring cells 3/15 (20%), perineural invasion 1/15 (6.7%), focal squamous differentiation 1/15 (6.7%), and a granulomatous inflammatory response 1/15 (6.7%). Immunohistochemical stains were negative for prostate specific antigen, prostate specific acid phosphatase, CDX2, and beta-catenin in all cases. Stains were positive for high molecular weight cytokeratin in 12/12 cases (100%), and CK7 and CK20 in 10/12 cases (83.3%). Prostatic urothelial-type adenocarcinoma is a rare aggressive cancer arising in the prostate. The differential diagnosis includes conventional prostatic mucinous adenocarcinoma and secondary infiltration from a colonic or bladder adenocarcinoma. Immunohistochemistry for prostate specific antigen, prostate specific acid phosphatase, and high molecular weight cytokeratin along with morphology can help rule out conventional

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; beta Catenin; CDX2 Transcription Factor; Cell Differentiation; Diagnosis, Differential; Follow-Up Studies; Homeodomain Proteins; Humans; Immunohistochemistry; Keratin-20; Keratin-7; Male; Middle Aged; Mucins; Neoplasm Invasiveness; Prognosis; Prostate-Specific Antigen; Prostatic Neoplasms; Protein Tyrosine Phosphatases; Time Factors; Urothelium

The differential diagnosis of mucin-producing adenocarcinoma of the prostate includes conventional prostatic adenocarcinoma with mucin production, secondary adenocarcinoma usually of colorectal origin and, very rarely, urothelial-type adenocarcinoma arising from either the prostatic urethra or proximal ducts. Conventional prostatic adenocarcinoma with mucin production is readily identified by routine microscopy and immunohistochemistry. The distinction between secondary adenocarcinoma and urothelial-type adenocarcinoma, however, can present a significant diagnostic challenge. In addition, documented examples of the latter in the prostate are exceptionally rare. A transurethral resection of prostate specimen and prostatic needle biopsies from two patients showing urothelial-type adenocarcinoma of the prostate were identified in our consultation files. One of the patients subsequently underwent a radical prostatectomy. Both patients had negative gastrointestinal endoscopic workups. Transurethral resection of prostate material from two patients with clinically confirmed secondary adenocarcinoma of colonic origin involving the prostate and a prostatectomy specimen with mucinous conventional prostatic adenocarcinoma were also identified for comparison purposes. Formalin-fixed, paraffin-embedded sections were stained for prostate-specific antigen (PSA), prostatic acid phosphatase, carcinoembryonic antigen, cytokeratin 7, cytokeratin 20 and high molecular weight cytokeratin 34betaE12. The urothelial-type adenocarcinoma cases were diffusely positive for cytokeratin 7 and focally positive for 34betaE12 and cytokeratin 20, consistent with an origin from the urothelium of the prostatic urethra or proximal prostatic ducts. In contrast, the secondary adenocarcinoma of colonic origin cases were diffusely cytokeratin 20 positive and either negative or focally positive for cytokeratin 7 and negative for 34betaE12. The mucinous conventional prostatic adenocarcinoma was positive for PSA and prostatic acid phosphatase and negative for cytokeratin 7, cytokeratin 20 and 34betaE12. All tumors were positive for carcinoembryonic antigen.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Carcinoembryonic Antigen; Carcinoma, Transitional Cell; Diagnosis, Differential; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Protein Tyrosine Phosphatases

We describe two cases of mucinous adenocarcinomas involving and confined to the prostate and originating from the prostatic urethra. These cases were identical to adenocarcinomas arising within the urinary bladder and differed from mucinous adenocarcinoma of the prostate. In both cases, an in situ adenocarcinoma component was identified in the overlying prostatic urethra. In one case the in situ adenocarcinoma arose in a villous adenoma of the urethra. Both cases contained lakes of mucin lined by tall columnar epithelium with varying degrees of cytologic atypia, and one case had mucin-positive signet cells. In contrast, mucinous adenocarcinomas of the prostate demonstrate tubules and cribriform glands floating within mucin; mucin-positive signet cells are rare. Both tumors were negative immunohistochemically for prostate-specific antigen and prostate-specific acid phosphatase and positive for carcinoembryonic antigen. One case was treated by radical prostatectomy, and the patient was without evidence of disease with short follow-up. Following simple prostatectomy, the other patient did not undergo definitive therapy for several years, at which point the tumor had progressed locally to an advanced stage. In terms of therapy, the distinction between mucinous adenocarcinoma or urinary bladder-type arising in the prostate depicted within the current study and mucinous adenocarcinoma of the prostate is significant.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Carcinoembryonic Antigen; Diagnosis, Differential; Humans; Immunohistochemistry; Male; Mucins; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms

A 77-year-old male was admitted for the examination of post renal acute renal failure. Blood examination revealed renal dysfunction and elevation of carcinoembryonic antigen (CEA). Computed tomography and retrograde pyelography showed bilateral hydronephrosis due to ureteral stenosis. He died of renal failure and autopsy was done. Histologic findings showed moderately differentiated adenocarcinoma of the prostate associated with endometrioid and mucinous carcinoma, and metastases of retroperitoneal lymph nodes and multiple bones. Immunohistochemically, endometrioid carcinoma was positive for prostatic acid phosphate (PAP) and prostatic specific antigen (PSA), and negative for CEA. Mucinous carcinoma was negative for PAP and PSA, and positive for CEA. Including our case, 29 cases of endometrioid and 32 of mucinous carcinoma of the prostate reported in the Japanese literature are reviewed.

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Aged; Carcinoembryonic Antigen; Carcinoma, Endometrioid; Humans; Immunohistochemistry; Male; Neoplasms, Multiple Primary; Prostate-Specific Antigen; Prostatic Neoplasms

The distribution of ALPase, ACPase, G6Pase TPPase and CCOase of gastric cancer and normal gastric epithelium were studied ultrastructurally. The results showed that normal gastric epithelium had no ALPase reaction. The reactions of ACPase, G6Pase, TPPase and CCOase were found in the corresponding organellae which were consistent with their functions. In tubular adenocarcinoma cells, their reactions were more apparent in the corresponding organellae. Some cells of tubular adenocarcinomas showed ALPase reaction. The mucinous adenocarcinoma cells had higher ACPase and TPPase reactions. In poorly differentiated adenocarcinoma cells, the five marker enzymes showed negative or faint reactions. The biological significance and mechanisms of distribution of the five marker enzymes were discussed.

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Alkaline Phosphatase; Biomarkers, Tumor; Glucose-6-Phosphatase; Histocytochemistry; Humans; Stomach Neoplasms

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Humans; Male; Neoplasm Invasiveness; Prostatic Neoplasms

We report a rare case of mucinous carcinoma of the skin with mammary infiltrating carcinoma-like patterns. An 82-year-old Japanese male had a gourd-shaped tumor on his scalp. Histopathologically, the posterior portion of the tumor showed small lobules of cuboidal tumor cells with no atypia floating in mucinous lakes. In the anterior portion, there were solid lobules, cords, and strands of anaplastic tumor cells infiltrating into the surrounding stroma. Enzyme- and immunohistochemistry and electron microscopy confirmed the eccrine origin of this tumor. It is suggested that mucinous carcinoma of the skin can occur in association with diverse histological patterns, analogous to mucinous carcinoma of the breast.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Alkaline Phosphatase; Carcinoma, Intraductal, Noninfiltrating; Glucuronidase; Humans; Male; Microscopy, Electron; Succinate Dehydrogenase; Sweat Gland Neoplasms

A mucinous adenocarcinoma of the prostate is rate, and a doubtful diagnosis should be verified to determine that the tumor surely does arise from the prostate, since a mucinous adenocarcinoma arising from the gastrointestinal tract is not as rare and often metastasizes to the prostate. We herein report on a case of a mucinous adenocarcinoma of the prostate, the origin of which was proved to be the prostate by immunohistochemical staining for a prostate-specific antigen and prostate-specific acid phosphatase.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Antigens, Neoplasm; Clinical Enzyme Tests; Humans; Immunohistochemistry; Male; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

Twelve patients with primary mucinous adenocarcinoma of the prostate were included in a clinicopathologic study; criteria included a total tumor volume more than 25% mucinous and single or clustered tumor cells floating in mucin lakes. Patient ages were 57 to 81 years; tumor stages were C (three), D (five), and unknown (four). Bone was the most frequent metastatic site (usually osteoblastic), followed by lymph nodes and lungs. Serum levels of prostatic acid phosphatase and prostate-specific antigen were frequently elevated (five of 10 and three of three measured, respectively). All mucinous adenocarcinomas also contained other histologic patterns: microglandular (four), cribriform (three), comedo (two), solid (two), and hypernephroid (one). Mucinous components composed less than 50% of three tumors, 50% and 75% of six, and more than 75% of three. No tumor contained signet-ring cells. Immunoperoxidase staining was positive for prostatic acid phosphatase and prostate-specific antigen and negative for carcinoembryonic antigen. Treatment was radiation, estrogen, orchiectomy, or a combination. In two of four patients, serum prostatic acid phosphatase levels normalized after therapy. Seven patients died of disease (mean follow-up, 56 months), and five patients are alive with disease (mean, 32.2 months). The proportion of mucinous component did not affect prognosis.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Antigens, Neoplasm; Carcinoembryonic Antigen; Histocytochemistry; Humans; Immunohistochemistry; Male; Middle Aged; Mucins; Prostate-Specific Antigen; Prostatic Neoplasms

Endobronchial metastases can manifest clinical symptoms and x-ray findings mimicking a centrally located bronchogenic carcinoma. The authors recently encountered a case of endobronchial metastasis from a mucinous adenocarcinoma of the prostate that was originally diagnosed as a primary bronchogenic carcinoma. The correct diagnosis was made on the basis of the morphologic similarities between the primary prostatic lesion and the lung lesion and was corroborated by immunohistochemical analyses.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Bronchial Neoplasms; Carbazoles; Carcinoembryonic Antigen; Humans; Immunohistochemistry; Male; Prostatic Neoplasms; Staining and Labeling

Signet ring cell adenocarcinoma (SRCA) is an extremely rare tumor of the prostate. We document with histochemistry, immunohistochemistry, and electron microscopy an incidental "signet ring" cell adenocarcinoma of the prostate in a fifty-seven-year-old white male with chronic lymphocytic leukemia who died of an intracerebral hemorrhage. The signet ring cells stained weakly for neutral mucin and were strongly positive for both prostate-specific antigen and prostate acid phosphatase. In addition, electron microscopy demonstrated intracellular lumina with microvilli and cytoplasmic vacuoles of mucin. This case conclusively supports the existence of SRCA of the prostate.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Antigens, Neoplasm; Biomarkers, Tumor; Humans; Immunoenzyme Techniques; Male; Microscopy, Electron; Middle Aged; Mucins; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

Primary signet-ring-cell carcinoma of the prostate is extremely rare. We report eight patients with prostatic adenocarcinomas containing significant numbers of signet-ring cells, one of whom presented initially with supraclavicular lymph node metastasis. Patient ages ranged from 50 to 80 years (mean, 67.5). None of the patients had received any form of therapy before biopsy or surgery. All patients presented with advanced disease (five with stage C and three with stage D). All tumors were poorly differentiated adenocarcinomas, M.D. Anderson Hospital system grade IV, Gleason's combined score of 9 or 10. The signet-ring cells were negative for neutral and acid mucins but immunoreactive for prostatic-specific antigen and prostatic acid phosphatase. Ultrastructurally, the signet-ring-cell appearance resulted either from the presence of intracytoplasmic lumina or from vacuoles. Signet-ring cells were also present at the metastatic sites. We conclude that (a) signet-ring-cell carcinoma of the prostate is a variant of poorly differentiated adenocarcinoma of the prostate; and (b) when a metastatic signet-ring-cell carcinoma with negative intracytoplasmic mucin is identified, a prostatic origin should be considered, and prostatic-specific antigen and prostatic acid phosphatase immunostaining should be performed.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Antigens, Neoplasm; Biomarkers, Tumor; Humans; Immunoenzyme Techniques; Lymph Nodes; Male; Microscopy, Electron; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

Mucinous adenocarcinoma of the prostate gland is one of the least common morphologic variants of prostatic carcinoma. A lack of precision in the definition of these mucinous neoplasms has resulted in reports which have overstated the incidence of this lesion. Of approximately 1,600 carcinomas of the prostate gland seen at Memorial Hospital from 1963 to 1983, excluding cases with only needle biopsy material, six mucinous prostatic adenocarcinomas were identified. Mucinous prostatic carcinomas were diagnosed when at least 25% of the resected tumor contained lakes of extracellular mucin, and an extraprostatic tumor site was ruled out. In five of the six cases, a cribriform pattern predominated in the mucinous areas. All of the mucinous prostatic tumors had prostate-specific acid phosphatase (PSAP) and prostate-specific antigen (PSA) immunoreactivity. Our experience and our review of the literature indicate that these tumors do not respond well to hormonal therapy. Contrary to prevalent opinion, they have an aggressive biologic behavior and, like nonmucinous prostate carcinomas, have a propensity to develop bone metastases and increased serum acid phosphatase levels with advanced disease.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Antigens, Neoplasm; Biopsy, Needle; Histocytochemistry; Humans; Immunochemistry; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

Primary mucinous adenocarcinoma of the prostate is rare. It is necessary to exclude extraprostatic primary sources, particularly from the gastrointestinal tract and the urinary bladder. Immunoperoxidase stain can serve the purpose of differential diagnosis. Usually, the presence of mucin in prostatic carcinoma is associated with a less aggressive tumor.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Diagnosis, Differential; Gastrointestinal Neoplasms; Humans; Immunoenzyme Techniques; Male; Mucins; Prostatic Neoplasms; Urinary Bladder Neoplasms

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms

Ten weekly doses of dimethylhydrazine (30 mg/kg) were given to rats to induce colonic tumors. Histochemical and electron cytochemical studies revealed a distinct pattern of lysosomal acid phosphatase and beta-glucuronidase activity in macrophages in the stroma of these neoplasms. A dramatic increase in the number of acid phosphatase-rich macrophages was present in adenomas when compared to that in normal colonic mucosa. Fewer numbers of these cells were seen in well-differentiated adenocarcinomas, and they were barely detectable in highly invasive mucinous adenocarcinomas. It is postulated that these macrophages may play a role in preventing the invasion of adenomatous neoplasms into the submucosa. Application of histochemical techniques to study macrophage lysosomal enzymes may prove a useful diagnostic tool in differentiation of human colonic tumors for prognostic evaluation.

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Adenoma; Animals; Colonic Neoplasms; Dimethylhydrazines; Glucuronidase; Lysosomes; Macrophages; Male; Methylhydrazines; Neoplasms, Experimental; Rats

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Adenocarcinoma, Scirrhous; Adenosine Triphosphatases; Carcinoma; Dihydrolipoamide Dehydrogenase; Electron Transport Complex IV; Glucosephosphate Dehydrogenase; Glycerolphosphate Dehydrogenase; Humans; Hydrolases; Isocitrate Dehydrogenase; L-Lactate Dehydrogenase; Leucyl Aminopeptidase; Oxidoreductases; Stomach Neoplasms; Succinate Dehydrogenase

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Adenocarcinoma, Scirrhous; Alkaline Phosphatase; Aminopeptidases; Cytodiagnosis; Gastric Mucosa; Glycosaminoglycans; Humans; Stomach Neoplasms

Topics: Acid Phosphatase; Adenocarcinoma; Adenocarcinoma, Mucinous; Alkaline Phosphatase; Connective Tissue; Endometriosis; Female; Histocytochemistry; Humans; Ovarian Neoplasms; Phosphoric Monoester Hydrolases

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Adenoma; Adenoma, Pleomorphic; Adenosine Triphosphatases; Adult; Aged; Alkaline Phosphatase; Carcinoma, Adenoid Cystic; Cystadenoma; Dihydrolipoamide Dehydrogenase; Female; Glucosephosphate Dehydrogenase; Histocytochemistry; Humans; Leucyl Aminopeptidase; Male; Middle Aged; Monoamine Oxidase; Parotid Neoplasms; Salivary Gland Neoplasms; Succinate Dehydrogenase